The Lost Children’s Drawings in a 19th-Century Medical Manuscript.

I’ve always been fascinated by marginalia in manuscripts – the comments written in the margins, the little drawings or doodles that someone absent-mindedly scribbled onto a piece of paper, in all likelihood blissfully unaware that someone would be reading them centuries later.

Remedy collections have always been a fruitful source for marginalia. The utilitarian nature of remedies invited comments and it’s common to find little notes about how well (or not) a particular remedy worked. This can be specific comments: One of my favourite was the addition ‘This I lyke’ next to a remedy for a cold I once came across. In another instance, an unfortunate patient had noted – next to a particular purge – that it was ‘too hot’ for him! Other things can include the pointing hand (known as a ‘manicule’) next to a favoured remedy, the word ‘probatum’, meaning ‘it is proved’ or, in other words, ‘it works’, and even a smiling face.

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(image from http://collation.folger.edu/2015/05/a-spoonful-of-sugar-helps-the-medicine-go-down/)

This week I’ve been working at the wonderful archive in the Barber Surgeons’ Hall in London. It’s a treasure trove of all sorts of documents relating to the history of the barber-surgeons, from account books to apprentice registers, wills, details of fines and freedoms, portraits, artefacts…even a box full of antique razors. It was great to spend time there, and to see some of the wonderful things in their collection: A huge Holbein painting, for example, or a cup that Samuel Pepys once quaffed from.

On this visit I was looking for information about barbers after the 1745 split, so was looking through various manuscripts. Occasionally, though, and usually when you’re not particularly looking for it, you come across a document that stops you in your tracks. On the desk was a 19th-century manuscript book comprising of notes taken from medical lectures given by John Abernethy, at the anatomy theatre in St Bartholomew’s hospital, London. Abernethy (1764-1831) was an English surgeon and Fellow of the Royal College of Surgeons. Having founded the medical school in St Bartholomew’s hospital in London, and been elected principal surgeon there in 1815, he had become lecturer in anatomy at the RCS in 1814.

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(Image taken by author – used by permission)

The note taker was one E. Long – part of a family hailing from Barham, Canterbury. Long was meticulous and methodical in his note taking. His pages were well ordered, neat and tidy, written in a fine Victorian script, with writing on just one side of each page, leaving the other blank. I’m not sure if Long continued his studies or went into practice afterwards, but the book remained in the family. There it might have stayed and perhaps still found its way into the archives as a fascinating record of the lectures of a prominent Victorian surgeon.

But at some point, perhaps years after, Long’s habit of leaving every other page blank proved tempting to certain younger members of the family. And they didn’t just add a few doodles on the odd page; they filled the reverse side of every page in the book with drawings, paintings, draft letters, copied passages from verses and even practised their writing. The book probably contains hundreds of these drawings, but I’ve picked just a few out.

One image, for example, depicts Victorian soldiers (“of the 93rd”)- perhaps copied from a book. The figure on the right, with his curly hair and beard, seems to have been the subject of particular attention.

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(Image taken by author – used by permission)

Another shows various heads in profile. Elsewhere in the book there are strong suggestions that some of these images were drawn from life, with an aunt and nanny being mentioned.

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(image taken by author – used by permission)

Another shows writing being practised, together with a less defined (and dramatically elongated) body, perhaps betraying the hand of a younger artist.

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(image taken by author, used by permission)

This next page of sketched faces reminded me strongly of the Dickensian ‘Boz’ character faces, with slightly grotesque, grimacing features.

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(image taken by author, used by permission)

Sometimes the children didn’t even pick a blank page. Was this their own house?

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(Image taken by author – used by permission)

A final one intrigued me: Captioned ‘Dick’s Drive to Dover’, with ‘The Accident’ written underneath, it seems like it might have been copied out of a novel or magazine. If anyone can identify it, I’d be delighted to know! IMG_3016

Aside from the obvious charm of the children’s additions, the book stands as a fascinating example of the multiple uses to which historical documents could be put and also, more broadly, the continued utility of books over long periods of time. This is something that early modernists are familiar with. Books – even manuscripts – were lent, gifted, exchanged, bequeathed and, in many cases, continued to be added to over years…sometimes even centuries. Remedy collections can be particularly long-lived in this respect. The Long family book shows the same process, with two completely different authors, the children’s drawings in sharp contrast with the stark medical language of the lectures. What would those children make of their drawings being ‘discovered’ 150 years later? Perhaps more importantly, what was Mr Long’s reaction when he found his lecture notes had become a child’s scribble pad?!

Robbing the Doctor: 17th-Century Medics as Victims of Crime

During the sixteenth and seventeenth centuries, a common complaint against medical practitioners was that they effectively picked the pockets of the sick, whilst doing little for them in return. As the Helmontian physician George Starkey remarked in the middle of the seventeenth century, the patient was “like to pay the price of the doctor fully with his life” – which Starkey regarded as a brave acte’!

But medics, just like anyone else, could sometimes be victims of crime. The records of the Old Bailey contain a fascinating list of these unfortunate practitioners, and the list of crimes and calumnies they suffered. More than this, however, they can offer an alternative glimpse into the world of early modern medical practice.

Old Bailey in the 19th century

(Old Bailey in the 19th century – image from Wikimedia Commons)

Sometimes, for example, physicians and other practitioners found themselves the victims of petty crime. In 1686, Edward Newgent of St Clement Danes pinched the periwig of an unnamed ‘Doctor of Physick’. The good doctor testified that he had been walking along the street in the evening, when the assailant whipped off his hat and wig, and pelted away down the street with them. The doctor gave chase and had the thief arrested. For this seemingly innocuous crime, the unlucky Newgent was sentenced to death!

Another victim of circumstance was Richard Allen of Holborn. In 1675, hearing a disturbance in the street, Allen, ‘by profession a Sea-Chirurgeon’, opened his door and was attacked by a mob (including bayliffs on the hunt for a person to serve a writ). Allen, was set upon by the men, ‘they hacking and hewing him without any mercy, that they left him dead upon the place’. So ‘mortal and dangerous’ were his wounds, that a ‘good part of his skull was taken clean off’.

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(Image from Wikimedia Commons)

At other times, the medicines or very tools of their trade might be targets for thieves. Surgeons, and their instruments, seem to have been a particular target. Instruments, especially high end examples, could be expensive and decorous, and were therefore worth taking. Consider the case of William Marriott, surgeon, whose house was broken into in October 1693 by the terrible trio of Batson, Dando and Bedford, ‘about 3 o’clock in the morning in a rude manner’. Swearing ‘great oaths’ and ‘offering to send his Soul to Hell’ they relieved him of £42 in cash, a gold locket and ‘a pair of forceps val. 4s, and other surgeons instruments besides’. All were acquitted.

March 1679 saw a “mischievous youth” slip into a barber-surgeon’s shop and observing that the barber was in another room, he made off with a “case of instruments, most of them tipt with Silver”. Crime didn’t pay for the errant youth; he was burnt in the hand for his trouble. A trio of thieves also relieved a London practitioner Peter Hillery of a “case of Chirurgeon’s Instruments” along with his sword. Hillery testified that he was “drinking in a Brandy shop” with one of the thieves, when he found the items missing. Quite why he felt the need to take his instruments to the pub with him is, unfortunately, not recorded.

Highway Robbery

(Image from Lewis Walpole Library)

Accosted by the highway robber, Daniel White, one John Delaphont was forced to stand and deliver ‘two boxes of surgical instruments, together with his hat, coat and shirt!

As well as the crimes themselves, some cases offer us a view into the world of what might be termed ‘irregular’ or ‘unorthodox’ practice. The descriptions of individuals are sometimes telling. In October 1679, for example, “several Bottels of a medicine called Elixar Vite” (otherwise known as ‘elixir vitae’ – a strong distilled water) were stolen from “a very ancient Itallian Gentel Man who has long professed Physick in this Kingdom”. The Italian was Salvator Winter, one of a string of European itinerant practitioners, who toured Britain in the mid seventeenth century, peddling their wares. In other sources, Winter was described as a ‘medical licentiate’, and signed letters testimonial to the skill of other practitioners. The servant of the unfortunate Winter was indicted, but later acquitted.

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(Image from Wikimedia Commons)

Another ‘unorthodox’ practitioner named Blagrave – “a pretender to physick” was relieved of a “Gold chain, a Medal, divers pieces of plate, several rich Cloaths, some Money &c”. The richness of the pickings from Blagrave highlights what a lucrative profession the practice of medicine could potentially be. To possess this level of goods suggested a man of means.

It wasn’t all one-way traffic however. As the records sometimes tell, medical practitioners could sometimes be tempted away from the path of righteousness. The exotically-named Toussaint Felix Urvoy was indicted of the heinous crime of stealing three china dishes in 1760. The case was complicated since Urvoy was owed money by the complainant, and claimed the dishes had been lent to him. Another witness described him as ‘a quack doctor’ who had befriended him in a public house (a pattern seems to be emerging here!) and said he ‘had some particular nostrums by which he could cure several disorders’.

Consider, though, the cautionary tale of the surgeon Stephen Wright, born to a wealthy Irish family, given a good education, versed in arithmetic and classics and sent to Dublin to be apprenticed to a prominent Irish surgeon. All was going well until…

“Unhappily for Stephen he chose to go by the Way of London, and to acquaint himself a little with England, the Place of his Nativity, whence his Forefathers came; tho’, as he said, his Father had a pretty good Estate, besides a handsome Sum of Money in Ireland, to which he was Heir, but by his desperate Misbehaviour, he has effectually prevented his inheriting either one or the other. For some Time after his coming to England, he served a Surgeon in the Country in Surrey, and might have done well, had he kept to his Business and been industrious, as he had good Education, and seemed capable of his Profession. His Friends had advanced to him 180 l. to bear his Expences at the Colleges in Paris. But he not content with that, resolved to improve this Sum, tho’ the Project he fell upon was wrong and foolish, and had no Success answerable to his Desire. In Effect he went to a Gaming-House in Covent-Garden, where in two or three Days, or at most a few Days, he lost the 180 l. designed to bear the Expence of his Travels, and then having no Money left, and not knowing what to do, but being destitute of the Grace of God, he resolved upon desperate Courses of Robbing.”

Given that so much focus is often upon the occupational lives of medical practitioners, it is interesting to see glimpses of their world through another lens. Lists of stolen items, for example, can be extremely useful in gauging what sorts of equipment physicians and surgeons owned, and where they took them. The terms by which medics were referred to and known is also revealing, not least in the colourful characters who sometimes inhabited the margins of medicine. The reason that I particularly like these records, though, is that they offer an intimate insight into the daily lives, frailties and misfortunes of a group of individuals, showing us a side of their lives not often reflected in the usual records of their medical occupation.

Beards, Masculinity and History.

The continuing popularity of beards over the past two years or so has surprised many. A mere few months after beards first became apparent, several media articles suggested that ‘peak beard’ had already been reached, and that the decline of facial hair was imminent. That was Summer 2012 and, despite repeated claims of its impending demise (some wrongly attributed to me!), the beard is still apparent as we near 2016. Several interesting things have accompanied this ‘trend’. First, it is the most sustained period of facial for around thirty years. Second, the style – the so-called ‘Hipster’ or ‘Shoreditch’ beard – may well prove to be the defining facial hair style of this generation, in a way, say, that ‘designer stubble’ recalls the rampant consumerism of Thatcher’s 80s. Furthermore, where male grooming products for men have catered for removing facial hair, a new market has emerged for beard care, including oils, moustache waxes and even beard moisturisers.

Aside from the issue of ‘how long will it last’, ‘what do beards mean’ is a common question. Indeed, it is a question that has repeatedly been asked through the centuries. The relationship between men and their facial hair is complex, but is usually closely bound up with prevailing ‘ideals’ of masculinity. At times in history the beard has represented a basic component of masculinity and manliness. Will Fisher’s work has shown how facial hair in the Renaissance formed part of medical understandings of gendered bodies, and the function of the four ‘humours’. Viewed as a waste product (in fact a type of excrement) it was seen as resulting from heat in the ‘reins’ – the area including the genitals. A thick beard thus spoke of virility and sexual potency, since it indicated the fires burning below. Not only was the beard held up as an ensign of manhood, it was a highly visible symbol of his ‘natural’ strength and authority.

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“Moroni Don Gabriel de la Cueva” by Giovanni Battista Moroni (circa 1525–1578) – http://www.all-art.org/baroque/portrait1.html. Licensed under Public Domain via Commons –

Remarkably similar claims were made for beards in mid-Victorian Britain, when the beard made a spectacular return to favour as the ‘natural’ symbol of a man. Everyone from writers such as Dickens and Thomas Carlyle, to physicians like Mercer Adams, were enthusiastically extolling the virtues of this “badge of manly strength and beauty”. More than this, as Adams argued, a moustache was “nature’s respirator while the hair covering the jaws and throat is intended to afford warmth and protection to the delicate structures in the vicinity, especially the fauces and the larynx”. (A. Mercer Adams, ‘Is Shaving Favourable to Health?: Edinburgh Medical Journal, Dec 1861). Here again, facial hair was closely bound up with themes of masculinity, health, male appearance and conduct.

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“Edward Bates – Brady-Handy” by Mathew Brady – Library of Congress Prints and Photographs Division. Brady-Handy Photograph Collection. http://hdl.loc.gov/loc.pnp/cwpbh.01083. CALL NUMBER: LC-BH82- 4097 <P&P>[P&P]. Licensed under Public Domain via Commons – https://commons.wikimedia.org/wiki/File:Edward_Bates_-_Brady-Handy.jpg#/media/File:Edward_Bates_-_Brady-Handy.jpg

The eighteenth century, however, represents something of an anomaly in the relationship between man and his beard. While much of the sixteenth, seventeenth and nineteenth centuries saw men wear at least some sort of facial hair, the eighteenth century has been described as the first truly beardless age in history. The exact reasons for this are unclear but, by 1750 beards, moustaches and whiskers were seriously démodé and, by 1800, the author William Nicholson was able to assert that “the caprice of fashion […] has deprived all the nations of Europe of their beards”.

In many important ways, this flight from the beard seems to run counter to what should have represented the masculine ideal. First, humoural understandings of the beard still prevailed. As such it was, at least technically, still an important component of the man. To shave it off, then, was to remove this important ‘signal’ of masculinity. Secondly, the eighteenth century was a period obsessed with the damaging effects of effeminacy in British men, not least in their ability to fight. Importantly this was not effeminacy, with its modern connotations of homosexuality, but literally becoming more feminine. Anxieties surrounded the feminising effects of Frenchified fashions upon young British men. The extreme form of new fashions was the ‘Macaroni’ – the foppish, bewigged and affected dandy. Even wigs were a source of tension in terms of their effect on male appearance. And yet, shaving the face actually rendered it more smooth and feminine.

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(Image from Wikimedia Commons)

Perhaps most interesting, however, is the apparent conflict caused by concepts of the ‘natural’. Nature underpinned the enlightenment, and much time and effort was expended in trying to uncover its meanings, and apply this to new ideals. The body was certainly part of this. Straightness in posture and deportment was considered components of the ‘natural body’. The artist Joshua Reynolds lauded the symmetry of perfect nature, suggesting the ‘Serpentine line’ of beauty, and suggesting that nature was the true model. The face was the most public of bodily surfaces, and smoothness, neatness and elegance were prized. But all of this glossed over the fact that the beard was in fact the natural state; shaving was inherently unnatural. Logically, if the beard was natural, why then get rid of it?

There are several potential reasons for the decline of the eighteenth-century beard, each of which highlights the close relationship between facial hair and contemporary ideals of masculinity. Social status certainly played a part. Whilst neatness and elegance were badges of the refined gentleman, facial hair marked out the uncouth rustic, the hermit, or the elderly derelict. This also raises the important issue of control. Just as enlightened masculinity championed rationality and manners, it also emphasised self-control as a key male feature. According to conduct literature of the time, whilst delicate ladies might blush and swoon, a man should remain in control of his senses and be measured in his emotions. The new vogue for shaving, spurred on by newly invented, sharper razors, fits this well, in terms of mastery and control over one’s own body.

Changing aesthetic ideals also fed into the freshly shorn face. The veneration of ancient sculpture, identified by George Mosse as an important element in the construction of manliness, yielded admiration at the smoothness and tactility of the stone, as well as the subjects. The obvious paradox was that many statues of Greek and Roman heroes were bearded, but this did not seem to have an effect. Coupled with this was the so called ‘cult of youth’. To affect a delicate, fey appearance was highly sought after in the later eighteenth century; shaving the face immediately rendered it more youthful.

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(Image ‘Statue of a youth in heroic repose – Mostra di Nerone, – from Wikimedia Commons)

More broadly, however, the shaven face almost literally reflected enlightened ideals of openness and enquiry. Shaving opened up the countenance to the world, in turn symbolising a mind open to new possibilities. In fact it was even acknowledged that beards were inherently masculine. What mattered, though, was the ability to be able to grow one, rather than the need to actually display it.

Through history, therefore, beards have been a central issue in the construction of masculinity and sexuality, but there is no simple, linear path to how they have been construed. At some points in time the beard has been the very symbol of sexual potency, authority and power. At others, however, the clean-shaven face has prevailed. In more recent times, indeed, shaving has become part of the grooming routines of men, and still strongly linked to health and hygiene.

One of the downsides of researching a topic like facial hair is that it carries perceptions of quirkiness. How, after all, can something as basic and mundane as the beard tell us anything about history? In fact, though, beards, moustaches, whiskers and beardlessness tell us a very great deal about the ways that masculinity, gender and sexuality have all shifted through time.

BBC Free Thinking Feature: Bamburgh Castle Surgery, c. 1770-1800

Over the past few years I’ve been working on the records of a unique eighteenth-century medical institution. The eighteenth century saw the rise of institutional medicine, first in the form of hospitals and infirmaries, and later dispensaries. The former were large, imposing buildings in a town landscape, housing inpatients and treating surgical cases, as well as other conditions. Dispensaries were smaller, sometimes occupying existing buildings, but generally acted as outpatient services where the poor could be given medicines, patched up if necessary, and sent on their way.

Both hospitals and dispensaries were funded by subscription. Subscribers were invited to pledge an annual sum of money, put towards the building, running and upkeep of the institution. In return, subscribers had the right to recommend patients for treatment, according to the size of their donation. Unlike today, patients could not simply turn up at the doors, unless in absolute emergency. Instead, they required a certificate of permission, signed by a subscriber and, as such, could be difficult to access at times.

Image from Wikimedia Commons
Image from Wikimedia Commons

Also, institutions were firmly urban in nature. They were closely bound up with the civic ambitions of Georgian towns. A hospital could be a strong statement about a town’s importance and beneficence to the poor. ‘See how kindly we look upon our poor objects’.

Unsurprisingly demand for these facilities was high. Even outside London, annual admissions could number in the thousands. Especially in the crowded and often unsanitary conditions of towns, conditions like epidemic fevers were rife.

But one medical institution stood apart – both literally and notionally – from the rest. In the 1770s, Dr John Sharp, Archdeacon of Northumberland, philanthropist, and member of a family which included a prominent surgeon and famous anti-slavery campaigner (Granville Sharp) was a trustee of a large charitable fund established by the late Nathaniel Lord Crewe. Crewe had set aside large amounts of money from land revenues, stipulating in his will that these were to be put to charitable use.

Image from Wikimedia Commons
Image from Wikimedia Commons

One of the properties was the dilapidated medieval Leviathan of Bamburgh Castle. Undertaking a massive programme of restoration, Dr John Sharp adapted the castle to a variety of charitable uses, including a school, corn charity, home for shipwrecked sailors and the surgery/infirmary.

With his brother’s advice (a surgeon at St Bartholomew’s hospital in London), Sharp equipped Bamburgh with the very latest in medical technologies, including an ‘electrical machine’ for literally electrocuting patients back to health, a full stock of medicines and equipment, and other modern apparatus such as the ‘machine for the recovery of the apparently dead’ – used to try and revive the recently-drowned.

L0011748 Title page: Report of the Society...recovery of persons

Last year I visited Bamburgh and made a short radio programme for BBC Radio 3, which is now available online.

Click on the link and then the ‘play’ icon in the new page to access the programme

For more about Bamburgh and its facilities, you can also click here for my ‘History Today’ article about Dr Sharp and his medical charity.

Overcrowded and Underfunded: 18th-Century Hospitals and the NHS Crisis

The problem of overcrowded hospitals in Britain is now an annually recurring one. Every year, especially in winter, operations are cancelled, treatments postponed and patients sent home because there simply isn’t bed space for them. A combination of increased admissions of the elderly in the winter months, seasonal outbreaks such as flu and norovirus, and the impact of weather-related accidents all serve to pile on the pressure to an already-embattled healthcare system.

Embattled Doctor!

According to the BBC, NHS and social care services are ‘at breaking point’, with an open letter warning the government that ‘things cannot go on like this’.http://www.bbc.co.uk/news/uk-29501588. The story is now a perennial one. Every year (and in fact every couple of months) a mix of underfunding, overcrowding and staff stress puts the NHS in the headlines. Winter almost always exacerbates the problem. A year ago the outgoing NHS Chief Executive David Nicholson warned that the “toxic overcrowding” of accident and emergency departments in Britain not only impacted upon service levels but could have far more serious effects including higher levels of patient mortality and unsustainable levels of staff stress. The president of the ‘College of Emergency Medicine’ went even further, stating that the whole system was sailing dangerous close to complete failure. With the Daily Telegraph claiming that many patients were afraid to ask for help from staff pushed almost to their limits, the United Kingdom is perhaps still in the midst of what it last year called, “David Cameron’s care crisis”.

Ann-NHS-demonstrator-dres-007 Image from http://www.TheGuardian.com

It is indeed easy to think of this situation as a uniquely modern one, linked to the seemingly continual squeeze on budgets. Surely this wouldn’t have happened in the past, where well-run hospitals staffed by starchy matrons ran their (spotlessly clean) wards with military precision? In fact, if we peer back through time to hospitals even before the NHS, the situation can look remarkably familiar.

In 1772 Dr John Sharp, a philanthropist and trustee of the charity established by the late Lord Crewe, established a charitable infirmary in the impressive medieval castle at Bamburgh on the north east coast of England. Sharp’s brother William was a celebrated surgeon at St Bartholomew’s hospital in London and so the infirmary was able to benefit from the advice of a top medical man. As such it was equipped with the latest medical technologies, from mechanically operated hot and cold seawater baths to electrical machines and even an infirmary carriage to take invalid patients down to the beach for a restorative dip. In terms of many other institutions this was state of the art.

Dr Sharp

Many hospitals of the time relied on subscriptions – donations by wealthy benefactors – for their building and running. For patients to be admitted required a letter of recommendation from a subscriber. It was therefore very difficult just to turn up and ask for treatment. Bamburgh was different. Funded completely by the charity it had an open surgery – effectively an accident and emergency centre – on weekends, which meant that anyone, but especially the poor, could attend and be seen with relative ease. A quick note from a local clergyman confirming their status as a poor ‘object’ was sufficient. Unsurprisingly, though, this very accessibility meant that it was extremely popular.

In the first year of the charity, the numbers of patients through its doors was a modest 206. In 1775 this had more than doubled, and in 1781 it treated 1106. By the end of that decade, the infirmary was regularly treating more than 1500 patients every year, and was expending more than £250 every year on treatments and drugs. As well as outpatients, the infirmary contained around 20 beds. To give some perspective, these numbers were at times comparable with some of the ‘flagship’ hospitals in major Georgian towns such as Bath and Birmingham.

Bamburgh Castle

A staff consisting of a surgeon, two assistants and several ancillary staff, alone catered for the influx of patients. On any given attendance day between 60 and 100 patients could attend, and this put immense strain on both facilities and staff. In 1784 a freezing winter and ‘melancholy weather’ caused many poor people to perish, and admissions to rise dramatically. Outbreaks of infection also increased the pressure. The ‘malignant smallpox’ in neighbouring parishes was a constant threat to families, while the winter of 1782 also brought an outbreak of influenza at the neighbouring military barracks at Belford. This elicited a plea for infected soldiers to be treated at Bamburgh – a request declined by Dr Sharp for fear of infecting the rest of his patients.

The resident surgeon, Dr Cockayne, keenly felt these increasing pressures. Writing to Dr Sharp in the 1780s he noted both the continual increase in duties and the ‘vast number of patients admitted’ all of which added to his great worry and trouble. In the politest possible terms he asked for a rise in his wages, a request that led to him moving from ad hoc payments to a permanent wage.

The overcrowding at Bamburgh certainly chimes with the problems faced by the NHS on a daily basis. In simple terms there are simply too few staff to look after too many patients. The demands of an ever-changing medical environment increase the workload for staff, and these lead to further questions about pay and conditions. But it is interesting to consider that while Bamburgh infirmary faced the same socio-medical conditions as do hospitals today the question of funding was markedly different. Bamburgh was a well-funded institution. It had abundant money to spend on facilities and equipment and did so. And yet, the pressures of increasing numbers, and the unpredictability of admissions, still threatened to overwhelm it. Does this suggest that at least some problems are not simply reducible to finance?

Many suggestions have been put forward, from streamlining the allocation of beds to increasing the range of conditions treatable by pharmacists and GPs and even treating some conditions in the patient’s own homes. Whatever the answer it is clear that hospital overcrowding is not a new problem. Medical professionals in the past were all too familiar with the challenge of meeting increasing and uneven demand with limited resources.

‘He is gone from his service before his time’: Medical Apprenticeships in Early Modern Britain

One of the biggest frustrations in studying Welsh medical history is the lack of institutions. In the early modern period Wales was unique amongst the individual nations of the British Isles in having no universities and no medical training facilities. Unlike England, Scotland and Ireland there were no colleges of physicians or surgeons. Why was this? One of the main reasons was the lack of large towns. Wrexham, in north Wales, was by far the largest town in early modern Wales, with a population of around 3500 in 1700. There were many other smaller Welsh towns but, without large populations to cater for, there was no need for practitioners to form trade gilds or corporations.

Over the past few weeks, however, I’ve been turning my attention to the Welsh Marches – the border between England and Wales – and doing some research on large towns such as Shrewsbury and Chester, which were important centres for Welsh people and, it seems, for Welsh practitioners too. One area that I’ve been particularly interested in is that of medical companies and trade guilds. As part of our project in Exeter, we’ve been looking in more detail at the role of barbers and barber surgeons in medicine, both in terms of what they did and how they were described, but also exploring the important question of medical apprenticeships. One company in particular, the Chester Company of Barber Surgeons and Wax and Tallow Chandlers is a particularly rich source of evidence.

L0048991 Arms of the London Barber Surgeons' Company. Engraving

The Company were responsible for the regulation of barbers, barber surgeons as well as chandlers who made candles and soap. The relationship between the trades may not immediately be apparent but, in fact, was often interchangeable. People described as barbers were commonly medical practitioners as well as hair cutters and beard trimmers. Barber surgeons often ran barbering shops. The gap between them was extremely fuzzy.

But also, for reasons that are less clear, barbers might also make and sell candles. In the records, barbers can be found referred to as wax chandlers (ie those making wax candles), or as both. Wax candles were relatively expensive since they burned for a long time. Interestingly, however, there appears to be no overlap between barbers and tallow chandlers. Tallow was animal fat, used in candle production. Although tallow candles were cheap, and as bright as wax candles, (around half the price of wax, or less) they burned for only around half the time, so were less effective.

Tallow candles

In conjunction with the borough the Company regulated trade and practice, laid out rules for members and also oversaw apprenticeship. Membership bestowed certain rights but also carried responsibilities. Brethren who did not abide by the rules risked censure and fines…and the list of rules was long!

Some orders were routine and concerned attendance and appearance. Every member was expected to attend all meetings unless they had a valid reason, and to wear their gown. They should ‘behave themselves orderly’, not disturb or interrupt meetings and should always call their fellow members by their proper names…on pain of a fine. Other rules related to respect and civility. One brother of the company should not ‘dispraise anothers work’ nor lodge any lawsuit against a fellow member. Neither should they disclose any secrets of their work to lay people, nor give out details of the meetings.

All fees (fines) were to be promptly paid and recorded in the register. These paid for the costs of meetings and food, but also for the burial of departed bretherin. Rule number 14 provided for ‘the decente and comely burial of any of the saide companye departed’ and it was expected that every member should ‘attend the corpse and burial’ unless they had good reason. The fine for non-attendance was a hefty 12 shillings!

Popular culture and religious belief also features strongly. An ‘order against trimming on Sundays’ forbade the cutting of hair on the Sabbath day, again for a fine of 20 shillings. Every year the company also participated in a popular midsummer parade and festival in the city. This involved a procession of decorated carnival floats, and was a throwback to an ancient pagan ceremony. Unusually, it continued long after the Reformation and also survived the Puritan assault on popular revelries. In 1664, an order stated that money should be set out for the stewards to arrange for a small boy (a ‘stripelinge’) to be dressed and ride Abraham, the Company’s horse, in the procession, and to ‘doe their verie best in the setting forth of the saide showe for the better credit of the said societie and company’.

Chester midsummer festival
(Left image: public domain; right licensed under Creative Commons-Attribution-Noncommercial-Share Alike 2.0 Generic)

Perhaps one of the most important aspects of the Company’s function was apprenticeship. The rules of apprenticeship were clearly set out, and this sheds light on a very important and under-researched area of medicine. Only freemen of city, and Company bretherin, were allowed to take on apprentices. Apprenticeships were usually for seven years, but this could vary according to individuals. According to the company rules, no brother should take on another apprentice until his current one was within the last year of his service. The fine for disregarding this rule was a ruinous £10! All apprentices were to be entered into the register or risk a 30 shilling fine.

Why people sent their children to be apprentices in medical professions is not always clear. Medicine was not regarded as a prestigious occupation and, indeed, surgery was sometimes analogous with butchery. Nonetheless an established business in a town could be lucrative, especially given the range of services that barbers provided. As such, the decision to enrol children with urban medics could be pragmatic.

Barber-surgeon with Scared Patient

A brief glance at the apprentice registers reveals a number of interesting points. Firstly, it is clear that apprentices were often drawn from a town and its hinterlands. Although some came from further afield, the majority were local or lived within roughly a twenty-mile radius. On 18th Feb 1615 Richard Howe was apprenticed to Edward Wright, barber and wax chandler of Chester, for 8 years. Nicholas Halwood of Chester joined Robert Roberts, Chester tallow chandler for 7 years, while Robert Shone of Broughton’s apprenticeship to a Chester chandler was for 12 years.

In some cases family connections were clearly important, and parents might apprentice their child to a brother, cousin or more distant kin. This was a useful means of drawing on connections to further a career. James Handcocke was apprenticed to his uncle William Handcocke, a barber and wax chandler in September 1613, while Robert Glynne was apprenticed to Richard Glynne to learn the art of barber surgery. Fathers might also take on their own sons as apprentices, a situation that must sometimes have led to fraught relations. Nicholas Cornley was apprenticed to his father Richard for 7 years in 1626, while others such as Robert Thornley, a barber surgeon and painter (!) took their sons to follow in their footsteps.

The conditions in which an apprentice lived and worked depended so much on their masters. While many were well-treated and provided for, which was in fact a central condition of apprenticeship, some masters could be cruel and neglectful of their young charges. Robert Pemberton’s service to Randle Whitbie ended 3 years into his 10-year indenture when he was found to be ‘gone from his service’. John Owen of Cartyd, Denbighshire, ‘ran away before his time ended’ as did Philip Williams, apprentice to Raphe Edge, who took to his heels after a year. Nothing is given as to the circumstances of their treatment; it was not unknown for apprentices to complain of ill treatment, however, and authorities took this seriously. In other cases the stark phrase ‘Mortuus est’ (he is dead) indicates another reason for the termination of an apprenticeship.

The number of entries and records for the company is huge, and will take a concerted programme of research to thoroughly investigate. It will also be interesting to compare these sources with other similar companies across Britain to build up a bigger picture of the activities of medical trades in early modern towns. Once this is done we should have a much broader picture of the role, function and daily activities of medical practitioners in the past.

The Agony and the Ecstasy: Hunting for 17th-century medics with few sources!

At the moment I’m once again on the hunt for elusive Welsh practitioners in the early modern period. The idea is to try and build up a map of practice, not only in Wales, but across the whole of the country. Once this is done we should have a clearer picture of where practitioners were, but also other key factors such as their networks, length of practice, range and so on.

Working on Welsh sources can at times be utterly frustrating. For some areas and time period in Wales sources are sparse to the point of non-existence. Time and again sources that yield lots of new names in England draw a complete blank in Wales. Ian Mortimer’s work on East Kent, for example, was based on a sample of around 15000 probate accounts. This enabled him to draw important new conclusions about people’s spending on medical practitioners in their final days. For Wales there are less than 20 probate accounts covering the early modern period!

17thc Wales

Wales had no medical institutions or universities, so there are no records of practitioners’ education or training. Welsh towns were generally smaller than those in England – the largest, Wrexham, had around 3000 inhabitants by 1700 –and this had a limiting effect on trade corporations and guilds. As far as I can tell there were no medical guilds in Wales between 1500-1750. It is also interesting to note that relatively few Welsh medics went to the trouble of obtaining a medical licence. A long distance from the centres of licensing in London, it could be argued that a licence was simply not necessary. Coupled with this was the fact that there was virtually no policing of unlicensed practice in Wales…only a bare few prosecutions survive.

The common perception has long been that there were simply few practitioners in early modern Wales. In this view, the vacuum left by orthodox practice was filled by cunning folk, magical healers and charmers, of which there is a long Welsh tradition. When I wrote Physick and the Family I suggested that there was a hidden half to Welsh medicine, and that if we shift the focus away from charmers etc then a much more nuanced picture emerges. When I began my search in earnest on this project, I was (and still am) confident that Welsh practitioners would soon emerge in numbers.

Cunning folk

At the moment, however, the number stands at around the 600 mark. This includes anyone identified as practising medicine in any capacity, and in any type of source, roughly between 1500 and 1750. So, 600 people engaged in medicine over a 250 year period, over the whole of Wales. Admittedly it doesn’t sound much! As a colleague gently suggested recently, this puts the ratio of practitioner to patient in Wales at any given time as roughly 1-50,000!

Here, though, the question is how far the deficiencies of the sources are masking what could well have been a vibrant medical culture. How do you locate people whose work was, by its nature, ephemeral? If we start with parish registers, for example, their survival is extremely patchy. For some, indeed many, areas of Wales, there are simply no surviving parish records much before 1700. Add to that the problem of identifying occupations in parish registers and the situation is amplified. How many practitioners must there be hidden in parish registers as just names, with no record of what they did? It is also frustrating, and probably no coincidence, that the areas we most want to learn about are often those with the least records!

Welsh registers

Records of actual practice depend upon the recording of the medical encounter, or upon some record of the qualification (good or bad), training, education or social life of the practitioner. Diaries and letters can prove insightful, but so much depends on the quality and availability of these sources. There are many sources of this type in Wales but, compared to other areas of the country with broader gentry networks, they pale in comparison.

All of this sounds rather negative, and it is one of the signal problems in being a historian of medicine in Wales of this period. In a strange way, however, it can also be a liberating experience. I have long found that an open mind works best, followed by a willingness to take any information – however small – and see where it can lead. Once you get past the desperation to build complete biographies of every practitioner you find, it is surprising what can actually be recovered.

In some cases, all I have is a name. Oliver Humphrey, an apothecary of a small town in Radnorshire makes a useful case in point. He is referred to fleetingly in a property transaction of 1689. This is seemingly the only time he ever troubles the historical record. And yet this chance encounter actually does reveal something about his life and, potentially, his social status and networks. The deed identifies him as an apothecary of ‘Pontrobert’ – a small hamlet 7 miles from the market town of Llanfyllin, and 12 from Welshpool. Immediately this is unusual – apothecaries were normally located in towns, and seldom in small, rural hamlets.

Pontrobert today

The deed involved the transfer of lands from Oliver and two widows from the same hamlet, to a local gentleman, Robert ap Oliver. Was this Robert a relative of Oliver Humphrey? If so, was Oliver from a fairly well-to-do family, and therefore possibly of good status himself? Alternatively, was Robert ap Oliver part of Humphrey’s social network, in which case what does this suggest about the social circles in which apothecaries moved?

Where there is a good run of parish registers, it can be possible to read against the grain and find out something of the changing fortunes of medics. Marriages, baptisms and deaths all point to both the length of time that individuals can be located in a particular place, and how they were identified. In some cases, for example, the nomenclature used to identify them might change; hence an apothecary might elsewhere or later be referred to as a barber-surgeon, a doctor or, often, in a non-medical capacity. This brings me back to the point made earlier about the problems in identifying exactly who medical practitioners were.

An example I came across yesterday was a bond made by a Worcestershire practitioner, Humphrey Walden, “that in consideration of the sum of £3 he will by the help of God cure Sibill, wife of Mathew Madock of Evengob, and Elizabeth Havard, sister to the said John Havard, of the several diseases wherewith they are grieved, by the feast of the Nativity of St John the Baptist next ensuing, and that they shall continue whole and perfectly cured until the month of March next, failing which he shall repay the sum of £3”.

Apart from the wonderful early money-back guarantee, this source actually contains a potentially very important piece of information. It confirms that a Worcester practitioner was treating patients in Wales – Evenjobb is in Radnorshire. Walden may have been an associate of John Havard and been selected for that reason. Alternatively, he may have had a reputation along the Welsh marches as a healer for certain conditions, and been sought out for that reason. It strongly suggests the mutability of borders though, and the willingness of both patients and practitioners to travel.

In other cases practitioners pop up in things completely unrelated to their practice. The only record I have of one Dr Watkin Jones of Laleston in Glamorgan occurs because he was effectively a spy for the earl of Leicester, being called upon to watch for the allegedly adulterous activities of Lady Leicester – Elizabeth Sidney. At the very least, however, it confirms his presence in the area, his rough age, and the fact that he was connected to a gentry family.

And so the search continues. My list of potential source targets is growing and I’m confident that a great many more Welsh medics are still there to be found. If, as I suspect, the final number is still relatively small, I still don’t accept that as conclusive evidence of a lack of medical practice in Wales. As the old maxim goes absence of evidence is not evidence of absence. What it might call for is a revaluation of Welsh cultural factors affecting medical practice and, perhaps, a greater and more inclusive exploration of medical practice, in all its forms in Wales.

Physick and the Family: health, medicine and care in Wales, 1600-1750 (Manchester: Manchester University Press, 2011)
Physick and the Family: health, medicine and care in Wales, 1600-1750 (Manchester: Manchester University Press, 2011)